CAJ | 학술논문

目的：回顾分析股骨近端髓内钉InterTAN和股骨近端抗旋髓内钉（PFNA）治疗不稳定型股骨转子间骨折的临床效果和手术并发症。方法选取我院自2012年1月至2013年8月手术治疗的不稳定型股骨转子间骨折患者57例，按照AO分型，A2型43例，A3型14例。分别采用InterTAN （34例）和PFNA（23例）内固定，比较两组之间的临床效果、手术损伤和手术并发症。结果术后切口均Ⅰ期愈合，无感染及皮肤坏死等早期并发症发生。手术时间：InterTAN组（26.1±11.5）min， PFNA组（24.2±15.5）min，无统计学差异（t=1.227，P=0.246）；术中出血量：InterTAN组（76.3±30.7）ml，PFNA组（71.5±38.5）ml，无统计学差异（t=1.362，P=0.185）；术中透视次数：InterTAN组（19.5±5.9）次，PFNA组（16.1±6.1）次，无统计学差异（t=1.779，P=0.086）；总计49例获得随访，其中InterTAN组29例，PFNA组20例，随访时间（15±4.6）个月。骨折临床愈合时间：InterTAN组（10.6±2.8）周，PFNA组（11.2±3.5）周，无统计学差异（t=0.860，P=0.392）；髋关节功能评分（Harris评分法）：InterTAN组（86.7±5.4）分，PFNA 组（88.5±7.6）分，无统计学差异（t=0.712， P=0.455）；术后并发症：InterTAN组出现1例髋内翻和2例下肢深静脉血栓（并发症发生率10.3%）；PFNA组出现1例髋内翻和1例下肢深静脉血栓（并发症发生率10.0%），两组并发症发生率比较无统计学差异（χ2=0.001，P=0.990）。结论 InterTAN和PFNA均具有手术时间短、术中透视次数少、术中出血量少和术后并发症发生率低的优点，两者均适用于不稳定型股骨转子间骨折病例。
목적：회고분석고골근단수내정InterTAN화고골근단항선수내정（PFNA）치료불은정형고골전자간골절적림상효과화수술병발증。방법선취아원자2012년1월지2013년8월수술치료적불은정형고골전자간골절환자57례，안조AO분형，A2형43례，A3형14례。분별채용InterTAN （34례）화PFNA（23례）내고정，비교량조지간적림상효과、수술손상화수술병발증。결과술후절구균Ⅰ기유합，무감염급피부배사등조기병발증발생。수술시간：InterTAN조（26.1±11.5）min， PFNA조（24.2±15.5）min，무통계학차이（t=1.227，P=0.246）；술중출혈량：InterTAN조（76.3±30.7）ml，PFNA조（71.5±38.5）ml，무통계학차이（t=1.362，P=0.185）；술중투시차수：InterTAN조（19.5±5.9）차，PFNA조（16.1±6.1）차，무통계학차이（t=1.779，P=0.086）；총계49례획득수방，기중InterTAN조29례，PFNA조20례，수방시간（15±4.6）개월。골절림상유합시간：InterTAN조（10.6±2.8）주，PFNA조（11.2±3.5）주，무통계학차이（t=0.860，P=0.392）；관관절공능평분（Harris평분법）：InterTAN조（86.7±5.4）분，PFNA 조（88.5±7.6）분，무통계학차이（t=0.712， P=0.455）；술후병발증：InterTAN조출현1례관내번화2례하지심정맥혈전（병발증발생솔10.3%）；PFNA조출현1례관내번화1례하지심정맥혈전（병발증발생솔10.0%），량조병발증발생솔비교무통계학차이（χ2=0.001，P=0.990）。결론 InterTAN화PFNA균구유수술시간단、술중투시차수소、술중출혈량소화술후병발증발생솔저적우점，량자균괄용우불은정형고골전자간골절병례。
Objective To compare the effects and complications of InterTAN nail versus proximal femoral nail antirotation (PFNA) in treatment of unstable intertrochanteric fractures. Methods Between January 2012 and August 2013, a total of 57 patients with unstable intertrochanteric fractures were retrospectively reviewed. According to AO classification, there were 43 cases of type A2, and 14 cases of type A3. All cases treated with InterTAN (34 patients) or PFNA (23 patients). The clinical data of surgical trauma, postoperative function and complications of the 2 groups were statistically compared in this study. Results All incisions healed by first intention; No complications of infection and necrosis occurred. The operative time was (26.1±11.5) min in InterTAN group, and was (24.2±15.5) min in PFNA group, showing no significant difference (t=1.227, P=0.246); Intra-operative active blood loss was (76.3±30.7) ml in InterTAN group, and was (71.5±38.5) ml in PFNA group, showing no significant difference (t=1.362, P=0.185); Fluoroscopy frequency was (19.5±5.9) times in InterTAN group and (16.1±6.1) times in PFNA group, showing no significant difference (t=1.779, P=0.086); 29 cases by InterTAN and 20 cases by PFNA had obtained follow-up (15±4.6) months. The healing time was (10.6±2.8) weeks in InterTAN group, and was (11.2±3.5) weeks in PFNA group, showing no significant difference (t=0.860, P=0.392). The harris hip score was (86.7±5.4) in InterTAN group, and was (88.5±7.6) in PFNA group, showing no significant difference (t=0.712, P=0.455). During the follow-up, complications occurred in 3 cases in InterTAN group and 2 cases in PFNA group. In InterTAN group, one case had hip varus, two cases had deep venous thrombosis (DVT). In PFNA group, one case developed to hip varus and the other one had DVT. The incidence of complications was 10.3% in InterTAN group and 10.0% in PFNA group, showing no significant difference (χ2=0.001, P=0.990). Conclusion Both InterTAN and PFNA have the advantage of short surgical time, fewer intraoperative fluoroscopy, less intraoperative blood loss and lower incidence of postoperative complications. This characteristic is suitable for them to treat the case of unstable intertrochanteric fractures.